Pa. Would Bar Inducements To Withhold Care

January 1, 1998

Managed care gag rules limiting the information physicians can give patients about coverage and treatment options would be outlawed under provisions of a bill approved last month by the Pennsylvania Senate's Public Health and Welfare Committee.

The measure also would bar plans from using financial incentives to discourage doctors from rendering care they deem medically necessary, or to reward them for giving less than medically necessary care.

All members would be able to continue to see their physicians for two months after the physician left a plan, and women who switched plans in mid-pregnancy could see the same physician through post-partum care even if the doctor wasn't in the plan.

A provision that would have given physicians final say over health plans when ordering or rejecting medical procedures was dropped, though language guaranteeing coverage of services if a physician determines them to be medically necessary remains in a bill making its way through the House.